Yep, that’s right: most babies get the Hepatitis B vaccine in the hospital, just hours after they are born. Most of the time this happens without the parent’s consent - or without even telling the parents that it’s happening. In fact, if your birth happens in a hospital or birthing center and you DON’T want your baby vaccinated for Hep B, you’ll likely have to tell the hospital or center that before hand, and tell them again and again before and after delivery.

Lets be clear: Hepatitis B is a very bad disease. As many as 1.4 million people in the US have Hep B, so it’s a fairly common condition. Hepatitis B can cause rapid liver failure (called fulminant liver damage), slower liver failure due to scarring (called cirrhosis) and liver cancer (a type of cancer called hepatocellular carcinoma). In adults, more than 90% of people who get infected with Hep B end up kicking the virus within a year, and don’t ever get sick from it. However this is not the case with infants - only 10% of infants are able to fight off the Hepatitis B virus. The other 90% will get very very sick from this infection, or even die.

How Common is Hep B in Infants?

There are only about 30 cases of Hepatitis B in infants every year in the US. How do they get it?

How Might an Infant Contract Hepatitis B?

There are two main ways infants can get Hepatitis B: from the parent who is giving birth to them, or from another family member in their home who is Hep B positive. This is why all parents or adults living with an infant should be tested for Hepatitis B. This can get a little tricky - there have been cases of people getting tested for Hepatitis B in the beginning of their pregnancies who became infected during pregnancy who didn’t find out till later. In addition, the Hepatitis B virus has an incubation period up to five months (though 90 days is closer to the average). So in an unvaccinated birth parent, it’s important to test for Hep B at the beginning and at the end of pregnancy, just to be sure.

Of the 30 cases of infants contracting Hep B in the United States every year, the vast majority get the virus from an undiagnosed birth parent during the birthing process.

If you or whoever is carrying your baby has Hepatitis B, then vaccination at birth is essential. Vaccination (along with treatment with hepatitis B immune globulin) can prevent 85-95% of transmission of hep B from a hep-B positive birth parent to their infant.

What about Infants with Hep B Negative Parents?

If someone's parent or caretakers are Hep B negative, the only other way that they can get Hepatitis B is via sexual contact or blood exchange (such as sharing needles, getting tattoos, etc). While it is present in other fluids, like saliva and tears, according to the CDC there is no documented proof that kids (or anyone) can get Hepatitis B through casual contact, such as kissing, sharing utensils, or drinking out of the same cup (sharing a toothbrush can be an issue if your gums are bleeding and their gums are bleeding. In that case and in every case: don’t share a toothbrush. That’s gross).

And Yet...

Despite the fact that most infants are unlikely to engage in this type of high risk behavior (teenagers are another story), even babies born to parents who are Hep B negative will be automatically given the Hepatitis B vaccine. They get this vaccine at birth, then again at 1-2 months, and the third dose between 6-18 months.​

So… if infants with Hep B negative parents are so unlikely to get the virus, why do we vaccinate for hep B at such an early age?

The Hepatitis B Initiative

The infant Hepatitis B vaccine is part of a public health initiative to get rid of the virus in the adult population in the US. Starting in the 80’s and 90’s various states and organizations began initiating "birth dose" initiatives, in hopes of both protecting infants whose birth parent had an undiagnosed Hep B infection and of eventually eradicating Hep B in our general population. Since then, giving the Hepatitis B vaccination at birth has become increasingly common - current estimates are that 70% of hospital-born infants are vaccinated in the hospital soon after birth.

Since initiating infant and adult vaccination programs, better donor blood screening, needle exchanges, safer-sex education, and various other public health programs aimed at decreasing Hepatitis B infection rates in the US, the rate of acute Hep B infection has fallen from it’s all-time high of 25,000 cases per year in the mid 1980’s to under 5,000 cases per year today(mostly in adults - there are around 30 cases per year reported in infants, 30 more in kids under 6, and around 90 per year in older kids and adolescents). This dramatic decrease in acute infection rates is pretty awesome, because Hepatitis B, like I said, is a very bad disease. ​

So Why Do Some Parents Decide Not to Vaccinate for Hepatitis B?

One of the biggest issues I (and many other doctors and parents) have with vaccinating at birth is that a baby’s immune system is not fully mature till around the second year of life. Most babies have circulating antibodies in their blood from their birth parent for about 6 months (whatever the birth parent was immune to, so is the kid), and after that they rely on passive immunity from breast milk (if they are breastfed) till their immune system is fully mature, which happens between 18 and 24 months of age.

A big part of our immune system is our T-cells. There are two main types of responses our T-cells can have: one is for killing bugs, such as bacteria and viruses (called a Th1 response), while the other is for mounting an allergic-type response (called a Th2 response). A Th2 response is often at work with conditions like seasonal allergies, food allergies, asthma, and eczema.​

The infant immune system has a hard time responding to bacteria and viruses (the Th1 response). It’s easier for a baby’s immune system to respond by mounting Th2 response. There are some theories that giving infants vaccines before 2 years of age can increase the Th2 response even more, pushing their immune system towards more of these reactive conditions such as allergies, eczema, and asthma. There isn’t currently a lot of evidence to support or deny this theory.

However, there have been some informal surveys of parents of both vaccinated and unvaccinated kids comparing rates of allergies, asthma, and autism. The most famous of these is an ongoing survey of around 12,000 kids by a very decidedly anti-vaccination German website impfschaden.info (the German counterpart to vaccineinjury.info). In those surveys, parents of unvaccinated kids reported significantly lower rates of asthma, allergies, autism, and ADHD, as compared to kids who were vaccinated.

Some parents chose not to vaccinate their kids before age two, just to avoid any risk of increasing their child’s chance of developing these and other allergic or inflammatory-type conditions.

In addition to concerns over allergies, there are some specific risks associated with the hepatitis B vaccine.

Specific Risks Associated with the Hepatitis B Vaccine

- Aluminum. Hepatitis B vaccine contains around 250 mcg of aluminum per dose. While this is a fairly small amount, aluminum can build up in the system and cause a wide variety of neurological issues. While the FDA has insisted that the level of aluminum in vaccines poses “extremely low risk” to infants, many parents are uncomfortable with the idea injecting heavy metals into their kids. ​

While the newborn Hep B vaccine is generally given by itself, an infant on the normal CDC schedule will get 5 different shots at their two month visit, three of which most likely contain aluminum (HIB, Pc, and DTaP). This can add up to as much as 1225 mcg aluminum in that single visit. There are few human studies that show the safety of injected aluminum at these levels.

- Autoimmune Disease Risk.Hepatitis B vaccine has a relatively high association with development of autoimmune disease, especially lupus and multiple sclerosis. There are hundreds of documented cases of this, but these have all been in adults. Infants rarely develop autoimmune conditions, though long-term autoimmune risk in people vaccinated as infants is harder to predict. That said, almost any infection (vaccine, virus, bacteria…) could theoretically lead to an autoimmune disease.

Other adverse effects reported after Hepatitis B vaccination include Stevens-Johnson syndrome, nerve dysfunction or paralysis, seizures, and inflammation of the blood vessels or the optic nerve. ​

Who Should Get the Hep B Vaccine, then?

Well, as I said before, babies whose have a parent or caretaker that is positive for Hep-B should always be vaccinated and treated with Hepatitis B immunoglobulin. But other people can be at high risk as well - teens and young adults who engage in risky behavior (as in, most of them), and especially anyone who works in a healthcare setting. In fact, if you work in a health care setting that involves any type of needles (for blood draws or injections) or contact with blood or bodily fluids the risk of contracting Hepatitis B in your lifetime is around 5 times higher than that for the general population (which is why most hospitals and many other medical facilities require employees to get vaccinated).​

A popular and quite reasonable option for parents who want their kids to be protected against Hepatitis B is to wait till their child is at least two years old or even an adolescent before giving the vaccine. This ensures that the child’s immune system is fully mature before receiving the vaccine, and still offers protection before the child is likely to engage in any high risk behavior.

Vaccination safetyis one of the most hotly disputed issues in parenting (and pediatrics) today, and despite how strongly both sides may feel, there is no obvious right or wrong choice when deciding whether or not to vaccinate. The best decision is an informed one!For more information, check out Dr Sears’ book on vaccinations for a great, well-balanced look at all the pros and cons of vaccinating your kids:
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​This blog is intended for educational purposes only.Information expressed herein does not constitute medical advice and in no way should be used as a substitute for the advice and attention of a qualified medical practitioner.

While many states offer regular medical licensing to naturopathic physicians, Michigan does not currently offer licensure to naturopathic doctors. I am licensed as a Naturopathic Doctor (ND) in the State of Vermont. In Michigan, until our licensing bill is passed, naturopathic medicine is not intended to diagnose, treat, or cure any disease and is not intended as a substitute for regular medical care. Because of this I work locally under the title Naturopathic Health Consultant.